Comparison of sterile normal saline and 1% povidone-iodine for vaginal preparation in vesicovaginal fistula: a randomised trial

Abstract

Background: Vaginal preparation before transvaginal gynecological surgeries improves the success rate. However, there is no consensus on which agent is superior for transvaginal repair of vesicovaginal fistula (VVF). We aimed to compare irritation symptoms and antimicrobial function between sterile normal saline (SS) and 1% povidone-iodine (PI) for vaginal preparation in surgical repair of VVF.

Methods: This randomised, controlled trial was conducted on patients with VVF underwent transvaginal repair. Preoperative vaginal irrigation was randomly performed with either SS or 1% PI. The patients' self-reported symptoms questionnaires, including numerical rating scale (NRS) of pain, Indevus urgency severity scale (IUSS), and vaginal symptoms, tissue edoema degree and pathogenic microbiology were recorded.

Results: The study included 30 patients in the SS group and 31 patients in the PI group. After twice irrigations before surgery, compared with the PI group, the SS group had a similar count of bacterial species but a higher bacterial load (p = .079 and p = .033). The NRS of pain and IUSS in the SS group were lower than those in the PI group (p < .001). The SS group had less severe vaginal symptoms (p < .001) and tissue edoema (p < .001) than the PI group. The successful repair rates were 86.7% in the SS group and 83.9% in the PI group (p = .758). Patients with more severe urinary and vaginal symptoms had lower successful repair rates (92.3% vs. 72.7%, p = .047).

Conclusions: SS is an effective vaginal preparation liquid for transvaginal repair of VVF with less irritation symptoms and acceptable antimicrobial function.

Keywords: Normal saline; povidone-iodine; vesicovaginal fistula.